54 STABCric 3: Surgical Technique Against Bougie Cricothyrotomy

Abstract

Study ObjectivesPerforming an emergent cricothyrotomy is a rare, yet life-saving surgical procedure performed at times of high operator stress. Simplified methods, such as the 3-step bougie-assisted cricothyrotomy have been suggested to optimize success. Most of these studies have only included emergency medicine practitioners, who are well trained in non surgical airway management. We sought to determine if our findings would be similar when general surgery residents were included.MethodsThis was an observational crossover study using pig trachea models. Participants included emergency medicine residents and general surgery residents at St. Luke’s University Hospital. Participants were randomized to one of the two techniques and trained with an instructional video prior to the procedure. After a 2-week washout period, the same participants were brought back to perform the other cricothyrotomy technique. The primary outcome measure was time to correct endotracheal tube placement.ResultsThirty seven emergency medicine residents and seven general surgery residents were included in the study (N=44). Compared to the surgical technique, the bougie-assisted cricothyrotomy was significantly faster with a median time to placement of 83 seconds (interquartile range [IQR] = 58-113 seconds) versus 139 seconds (interquartile range [IQR] = 98.5-267 seconds) for the surgical technique. Data were consistent in subgroup analyses as well. The general surgery residents (N=7) showed a median time to placement of 75 seconds (interquartile range [IQR] = 54-106 seconds) for the bougie-assisted technique versus 120 seconds (interquartile range [IQR] = 85-267 seconds) for the open surgical technique. The emergency medicine residents (N=37) showed a median time to placement of 83 seconds (interquartile range [IQR] = 58-113 seconds) for the bougie-assisted technique and 140 seconds (interquartile range [IQR] = 101-267 seconds) for the open surgical method.ConclusionThis study demonstrates that the bougie-assisted method is both quicker to learn and perform when compared to the traditionally taught open surgical cricothyrotomy. These results are consistent in both general surgery and emergency medicine residents as well as across PGY levels. Study ObjectivesPerforming an emergent cricothyrotomy is a rare, yet life-saving surgical procedure performed at times of high operator stress. Simplified methods, such as the 3-step bougie-assisted cricothyrotomy have been suggested to optimize success. Most of these studies have only included emergency medicine practitioners, who are well trained in non surgical airway management. We sought to determine if our findings would be similar when general surgery residents were included. Performing an emergent cricothyrotomy is a rare, yet life-saving surgical procedure performed at times of high operator stress. Simplified methods, such as the 3-step bougie-assisted cricothyrotomy have been suggested to optimize success. Most of these studies have only included emergency medicine practitioners, who are well trained in non surgical airway management. We sought to determine if our findings would be similar when general surgery residents were included. MethodsThis was an observational crossover study using pig trachea models. Participants included emergency medicine residents and general surgery residents at St. Luke’s University Hospital. Participants were randomized to one of the two techniques and trained with an instructional video prior to the procedure. After a 2-week washout period, the same participants were brought back to perform the other cricothyrotomy technique. The primary outcome measure was time to correct endotracheal tube placement. This was an observational crossover study using pig trachea models. Participants included emergency medicine residents and general surgery residents at St. Luke’s University Hospital. Participants were randomized to one of the two techniques and trained with an instructional video prior to the procedure. After a 2-week washout period, the same participants were brought back to perform the other cricothyrotomy technique. The primary outcome measure was time to correct endotracheal tube placement. ResultsThirty seven emergency medicine residents and seven general surgery residents were included in the study (N=44). Compared to the surgical technique, the bougie-assisted cricothyrotomy was significantly faster with a median time to placement of 83 seconds (interquartile range [IQR] = 58-113 seconds) versus 139 seconds (interquartile range [IQR] = 98.5-267 seconds) for the surgical technique. Data were consistent in subgroup analyses as well. The general surgery residents (N=7) showed a median time to placement of 75 seconds (interquartile range [IQR] = 54-106 seconds) for the bougie-assisted technique versus 120 seconds (interquartile range [IQR] = 85-267 seconds) for the open surgical technique. The emergency medicine residents (N=37) showed a median time to placement of 83 seconds (interquartile range [IQR] = 58-113 seconds) for the bougie-assisted technique and 140 seconds (interquartile range [IQR] = 101-267 seconds) for the open surgical method. Thirty seven emergency medicine residents and seven general surgery residents were included in the study (N=44). Compared to the surgical technique, the bougie-assisted cricothyrotomy was significantly faster with a median time to placement of 83 seconds (interquartile range [IQR] = 58-113 seconds) versus 139 seconds (interquartile range [IQR] = 98.5-267 seconds) for the surgical technique. Data were consistent in subgroup analyses as well. The general surgery residents (N=7) showed a median time to placement of 75 seconds (interquartile range [IQR] = 54-106 seconds) for the bougie-assisted technique versus 120 seconds (interquartile range [IQR] = 85-267 seconds) for the open surgical technique. The emergency medicine residents (N=37) showed a median time to placement of 83 seconds (interquartile range [IQR] = 58-113 seconds) for the bougie-assisted technique and 140 seconds (interquartile range [IQR] = 101-267 seconds) for the open surgical method. ConclusionThis study demonstrates that the bougie-assisted method is both quicker to learn and perform when compared to the traditionally taught open surgical cricothyrotomy. These results are consistent in both general surgery and emergency medicine residents as well as across PGY levels. This study demonstrates that the bougie-assisted method is both quicker to learn and perform when compared to the traditionally taught open surgical cricothyrotomy. These results are consistent in both general surgery and emergency medicine residents as well as across PGY levels.